The following comprehensive article by the Clinical Leads on Podiatry in Aberdeen and Grampian, has been submitted to us after a very lengthy re–organisation of who is responsible for the podiatry care of vulnerable or at risk patients in Aberdeen or Grampian.
I am very grateful to the two Clinical Leads for their time last winter, when I highlighted in an email, how GP Services, Podiatry Services and Diabetes Care were somehow disjointed, resulting in myself falling through a gap in the safety net for Diabetic Foot Screening.
The story is very complicated, but it is enough to say that my GP – or rather his specialist nurse was convinced that I was being seen at the “David Anderson “Building where Diabetes screening takes place for most patients in the Region. This usually involves retinal screening digital photography, or a small acoustic detector to check pulse strength in the feet. Other checks or referrals at the “David Anderson” building at Foresterhill might include nutrition, or other specialist advice.
The Clinical Leads listened very carefully to what I was saying when I went to Frederick Street Health Village to see them: that I in fact, did not attend the David Anderson Clinic, but I went straight to the Eye Clinic where I was being treated for Retinal Detachment caused by diabetic complications.
That meant I was somehow out of the loop of care, and although being seen biennially by my GP’s nurse, and regularly by a podiatrist separately, both did not do foot –screening or pulse testing
Neither do the Eye Clinic which is not designed for that function.
Foot screening involves the said acoustic pulse test and the “fibre test” which is the application of a strong fibre to the toes and feet at selected points to gauge reaction. Neuropathy or deadening of the nerves in the feet, and sometimes fingers, occurs with Diabetes. Although not a curable condition, patients who are detected with this lack of feeling, or Neuropathy – need to be aware of wearing slippers, and have their feet protected at all times. Damage to the feet by burning or having an object penetrate the foot, (because the patient may not feel the damage occur) can turn very nasty if the circulation in the foot is already compromised. Some folk cannot actually see or get down to inspect any damage, hence the necessary foot –screening and regular inspection.
The Clinical leads or Heads of Department, undertook months of research, involving all the GP surgeries in the region and the system has now been fixed, so that GP Surgeries make sure that no –one falls through the net like I did, and that a co-ordinated foot –care programme has been instituted in the whole region.
I can only thank both these caring and listening clinicians , from the Podiatry Service, for their time and understanding, and then taking action where or when they discovered misunderstanding, as regards the responsibilities or role of the GP’s in the Diabetes Foot Care screening programme.
May I also add that when one spots a problem in the system, then it pays to ask questions?